{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T09:23:32Z","timestamp":1787822612326,"version":"build-2784847793"},"reference-count":24,"publisher":"Wiley","issue":"8","license":[{"start":{"date-parts":[[2026,6,30]],"date-time":"2026-06-30T00:00:00Z","timestamp":1782777600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2026,6,30]],"date-time":"2026-06-30T00:00:00Z","timestamp":1782777600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["R01AG062568\u201003S1"],"award-info":[{"award-number":["R01AG062568\u201003S1"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["agsjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J American Geriatrics Society"],"published-print":{"date-parts":[[2026,8]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Anticholinergic exposure is common in nursing homes; however, the true burden may be underestimated, particularly due to over\u2010the\u2010counter agents such as first\u2010generation antihistamines that are not consistently captured in prior claims\u2010based studies. This gap limits accurate characterization of anticholinergic use and its clinical implications in older adults.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants and Setting<\/jats:title>\n                    <jats:p>\n                      Veterans aged \u2265\u200965\u2009years with stays \u2265\u200990\u2009days (\n                      <jats:italic>N<\/jats:italic>\n                      \u2009=\u200945,183) residing in US Department of Veterans Affairs (VA) Community Living Centers (CLC). This study is a secondary data analysis of residents identified during fiscal years 2007\u20132019.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>True anticholinergic exposure through barcode\u2010based medication administration dispensing records allowed daily measurement of anticholinergic exposure, with follow\u2010up extending from admission to discharge, death, or April 1, 2025. Anticholinergic medication use was defined as use \u2265\u20094\u2009days per week during the CLC stay. Drugs were identified using VA classifications aligned with the 2023 American Geriatrics Society Beers Criteria and grouped into nine anticholinergic classes. Outcomes included prevalence, duration, and number of anticholinergic drug classes used; patterns by dementia status; and temporal trends over time.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Among 45,183 CLC residents, 33.4% (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200915,074) used anticholinergic medications. Residents with dementia (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200920,254) showed substantial exposure to neuropsychiatric anticholinergics, including second\u2010generation antipsychotics (30.6%) and antiparkinsonian agents (10.1%). First\u2010generation antihistamine use remained high in this group (29.5%). Residents without dementia (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200924,929) more frequently received antihistamines (34.4%), bladder antimuscarinics (23.7%), and skeletal muscle relaxants (11.1%). From FY2007\u20132019, anticholinergic use declined modestly, with decreases in antihistamines (12.1%\u20138.8%), antidepressants (6.8%\u20133.5%), and antiemetic\/antivertigo agents (5.2%\u20131.2%). Most residents used a single anticholinergic class, increasing from 75.5% to 82.2% over time.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Although some anticholinergic classes may be clinically necessary, our findings highlight potentially underrecognized and modifiable sources of exposure, particularly first\u2010generation antihistamines, underscoring the need for deprescribing efforts.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/jgs.70570","type":"journal-article","created":{"date-parts":[[2026,6,30]],"date-time":"2026-06-30T22:16:08Z","timestamp":1782857768000},"page":"2285-2296","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Anticholinergic Medication Use in Veterans Affairs Long\u2010Term Care Residents: Clinical Patterns and Opportunities for Deprescribing"],"prefix":"10.1111","volume":"74","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6259-9456","authenticated-orcid":false,"given":"Cellas A.","family":"Hayes","sequence":"first","affiliation":[{"name":"Department of Epidemiology and Population Health Stanford University  Stanford California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yongmei","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Epidemiology and Population Health Stanford University  Stanford California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bocheng","family":"Jing","sequence":"additional","affiliation":[{"name":"Department of Epidemiology and Population Health Stanford University  Stanford California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laura A.","family":"Graham","sequence":"additional","affiliation":[{"name":"Health Economics Resource Center, VA Palo Alto Health Care System  Palo Alto California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chintan","family":"Dave","sequence":"additional","affiliation":[{"name":"Center for Health Outcomes, Policy, and Economics, College of Pharmacy Rutgers University  New Brunswick New Jersey USA"},{"name":"Center for Pharmacoepidemiology and Treatment Sciences, Institute for Health Rutgers University  New Brunswick New Jersey USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5974-3648","authenticated-orcid":false,"given":"Michelle C.","family":"Odden","sequence":"additional","affiliation":[{"name":"Department of Epidemiology and Population Health Stanford University  Stanford California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,6,30]]},"reference":[{"key":"e_1_2_9_2_1","unstructured":"Consumer Affairs \u201cAssisted Living Statistics \u201daccessed June 17 2023 https:\/\/www.consumeraffairs.com\/assisted\u2010living\/statistics.html."},{"key":"e_1_2_9_3_1","unstructured":"Kaiser Family Foundation \u201cTotal Number of Residents in Certified Nursing Facilities \u201daccessed June 15 2023 https:\/\/www.kff.org\/other\/state\u2010indicator\/number\u2010of\u2010nursing\u2010facility\u2010residents\/."},{"key":"e_1_2_9_4_1","unstructured":"Pan American Health Organization (PAHO) \u201cNumber of Older Adults With Long\u2010Term Care Needs Will Triple by 2050 PAHO Warns \u201daccessed June 15 2023 https:\/\/www.paho.org\/en\/news\/1\u20101\u20102019\u2010number\u2010older\u2010adults\u2010long\u2010term\u2010care\u2010needs\u2010will\u2010triple\u20102050\u2010paho\u2010warns."},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1007\/s40266\u2010017\u20100502\u20106"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.1002\/nau.24536"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.neubiorev.2021.04.031"},{"key":"e_1_2_9_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.maturitas.2021.06.004"},{"key":"e_1_2_9_9_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12877\u2010022\u201003235\u20109"},{"key":"e_1_2_9_10_1","doi-asserted-by":"publisher","DOI":"10.2500\/108854100778249033"},{"key":"e_1_2_9_11_1","doi-asserted-by":"publisher","DOI":"10.1111\/jgs.18372"},{"key":"e_1_2_9_12_1","doi-asserted-by":"publisher","DOI":"10.1097\/NAQ.0000000000000118"},{"key":"e_1_2_9_13_1","doi-asserted-by":"publisher","DOI":"10.1097\/MLR.0000000000000334"},{"key":"e_1_2_9_14_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamainternmed.2014.7663"},{"key":"e_1_2_9_15_1","doi-asserted-by":"publisher","DOI":"10.2147\/cia.s5358"},{"key":"e_1_2_9_16_1","doi-asserted-by":"publisher","DOI":"10.1002\/gps.4507"},{"key":"e_1_2_9_17_1","doi-asserted-by":"publisher","DOI":"10.1093\/gerona\/gln043"},{"key":"e_1_2_9_18_1","doi-asserted-by":"publisher","DOI":"10.1111\/jgs.19500"},{"key":"e_1_2_9_19_1","doi-asserted-by":"publisher","DOI":"10.5489\/cuaj.4114"},{"key":"e_1_2_9_20_1","doi-asserted-by":"publisher","DOI":"10.36131\/cnfioritieditore20240504"},{"key":"e_1_2_9_21_1","doi-asserted-by":"publisher","DOI":"10.1111\/jsr.14035"},{"key":"e_1_2_9_22_1","doi-asserted-by":"publisher","DOI":"10.1007\/s40263\u2010024\u201001078\u2010z"},{"key":"e_1_2_9_23_1","doi-asserted-by":"publisher","DOI":"10.1177\/2042098616659412"},{"key":"e_1_2_9_24_1","doi-asserted-by":"publisher","DOI":"10.1002\/14651858.CD015405.pub2"},{"key":"e_1_2_9_25_1","doi-asserted-by":"publisher","DOI":"10.1007\/s41999\u2010025\u201001371\u20100"}],"container-title":["Journal 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